Choices: Surgeons When faced with the need to choose a surgeon for your joint replacement, it can be overwhelming. How do you choose? How do you know? Well, for a start you can make a note of the questions below and then interview some surgeons to make sure you get a good one. I know friends will say to you 'Mr. X is highly/well respected in our area' or 'Mr X is the 'top' surgeon'. You might ask around and be told that those who had Mr. X do their hip or knee were delighted and found him ‘such a nice man’. Such recommendations are good but they're not everything. ALL surgeons are 'well respected' and have 'fans'. It comes with the job. But it means little if your hip is botched up and then you find others with problems popping out of the woodwork. Another phrase often heard is that Mr X is the 'top surgeon in his field'. What field? His locality? His hospital? His state/county? In whose opinion is he top? The general public? Patients who have had good outcomes? His professional peers? Personally, only the opinion of his professional peers would count with me as to whether a surgeon is top in his field or not since they would be the only ones capable of making such a judgement. Prostheses It's also easy to get overwhelmed by the mountain of information about different prostheses. Again, how do you choose? How do you know? Just be aware where you are getting your information from! Manufacturers have websites to promote their own products and are therefore naturally going to emphasise the positives in their own wares and compare them with the negatives of others. Examples: "We advocate the use of ceramic because it is known that wear particles from plastic liners causes tissue reactions" or "Metal on metal creates ions." Be sure and find the fine print in any website or any article you read to see exactly WHO is presenting the information. Many times it will be someone who has a financial stake in what is written, meaning you should consider that when you evaluate the information. Statistics: US: 225,900 primary hip replacements and 431,485 primary knee replacements were carried out in 2004 according to data from the Nationwide Inpatient Sample UK: 27,814 primary hip replacements and 75,629 primary knee replacements were recorded in the National Joint Registry in 2008 Of these, a very tiny number have problems, statistics show less than 1% overall. Materials: Metal on plastic has been the bench mark combination of materials since way back to the early sixties. Otherwise there is metal on metal, ceramic on plastic and ceramic on ceramic. Each have their own positive and negative aspects but suffice it to say that, in my opinion, choosing requires knowledge and skill and is a matter for the surgeon. All have been tried and tested over the years. Longevity: As for the longevity of the prostheses, the official line is 10-15 years, professionals reckon it to be 15-20. Statistics show it to be approaching 20-25 and maybe even more. There are many, many people walking around now, living good, productive and happy lives who had their replacements done in the 60s and 70s! There is a news report in the hip forum about a lady who had hers done in 1966! See 42 years life span for a hip replacement!! When will I be "ready" to have my joint replaced? First of all, read around the older threads here on BoneSmart and you'll see that a lot of other members have asked that very same question! Many continue to prevaricate even though they have cut back dramatically on the things that make their lives worthwhile. But ask yourself this: "Just how much more disabled do I want to be before I get that hip/knee fixed?" No one knows what's around the corner. Anything could happen. So if you wait another 5 or 10 years - you'll never get those years back. The simple fact about joint replacement - the primary objective of the procedure - is to give you back your life, to give you back your vitality and to give you back you! You won't discover that so much as REdiscover it! The upshot is that all hip and knee implants are pretty much tried and tested. Most have been around for years and although they have been 'redesigned' and refashioned from time to time, they are basically the same prosthesis. They have stood the test of time. What makes one operation a success and causes another to fail is mostly down to surgical skill and experience. My advice is this. Choose your surgeon carefully and ask him these questions (print these off and take them with you) 1. How long have you used your current prosthesis and what are your reasons for having selected it? 2. How many (knee/hip) surgeries do you do each year? (Anything over 200 is good; 300+ is better) 3. What is your infection rate? (0.5% or less is good) 4. What is your incidence of short term complications? (dislocations, wound infections) 5. What is your incidence of long term complications? (infections, loosenings, breakages of prosthesis, clicking, clunking, unidentifiable pains, need for manipulations) Any surgeon worth his salt will not only be ready and willing to discuss these questions, but will have the figures ready to provide to you. Any hint of reluctance, offense or waffle - go find yourself another surgeon! Once you have found a surgeon whose responses you feel comfortable with, accept whatever prosthesis he uses as you can trust that it has a better than average track record. Though to be honest, most do anyway. All the best in your journey to a new joint!